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way. These funds provide incentives to students to enter these nursing programs,

especially helping to finance minority students in need of education stipends.

Directors of all thirty educational programs are also seeking additional sources of

funding -- from state governments, from private foundations and from faculty generating

service dollars. This later practice is dependent on the state laws under which a CNM

is licensed, as well as the CNM's ability to gain hospital privileges -- barriers to practice

which still restrict nurse-midwifery in some areas of the country. In fact, the availability of

this option for nurse-midwifery faculty is much more limited than for faculty at medical

schools. Faculty are further limited since they provide care for underserved patients and

this type of health care service cannot subsidize the educational programs.

Return on Investment

The federal funds that have been spent over the past ten years on nurse-midwifery

education have been repaid many times over by CNM's services to the poor and

underserved in the United States.

Today, nurse-midwifery practices exist in all 50 states, and in many developing

countries around the world. Certified nurse-midwives can be found in hospital settings,

in clinics, and in privately owned birthing centers. Fortunately the tradition of providing

care to the poor continues. This is especially important in light of information which

indicates that obstetricians are caring for smaller numbers of Medicaid clients.

A Safe Cost Effective Alternative

Over the years nurse-midwives have maintained a superb record of safety and

client satisfaction. Nurse-Midwifery is also a highly cost-effective approach to health care

delivery. Hospital stays tend to be shorter and care regimens less technologically

complex when not medically necessary with nurse-midwife assisted deliveries.

A Significant Contribution To Healthier Births

One of the maternal and infant health objectives set by Healthy People 2000 is to

: "Increase to at least 90 percent the proportion of all pregnant women who receive

prenatal care in the first trimester of pregnancy". This objective is imperative since early,

high-quality prenatal care is critical to improving pregnancy outcomes and reducing A number of studies have shown that care by nurse-midwives increases utilization of prenatal care facilities, and that such care lowers the risk of low birthweight, prematurity

neonatal mortality.

and neonatal death. Recent reports by the National Academy of Science's Institute of

Medicine, the Southern Governors' Association Task Force on Infant Mortality and the

Children's Defense Fund highlight nurse-midwives' outstanding contribution to preventing

low birthweight

Another objective stated by Healthy People 2000, 'Increase to at least 60 percent

the proportion of primary care providers who provide age-appropriate preconception care

and counseling' also can be achieved by using nurse-midwives as providers. Certified

nurse-midwives endure that their patients are healthy prior to pregnancy, there by

reducing the risk of problem pregnancy and poor outcome. We care for all women

regardless of income, social status, or ethnic background.

Present Needs

At this time we are requesting $20.000.000 to meet the educational needs of

nurse-midwives/nurse practitioner programs.

Presently, only nine nurse-midwifery

programs are being funded. The additional funding requested is only enough to fund 4

6 additional new nurse-midwifery/nurse practitioner programs. These funds will help

afford student scholarships as well as provide educational supplies, equipment and help

pay for faculty salaries.

The program at Georgetown University graduates 15 students annually.


The American College of Nurse-Midwives urges Congress to appropriate funding

levels adequate for the educating of sufficient numbers of nurse-midwives and other

nurses with advanced nurse education.

Certified nurse-midwives have a rich tradition of providing access to care for the

poor and other underserved, populations. This service more than compensates

for the federal funding which has supported the educational programs in the past.

Continued growth of nurse-midwifery in the United States will help address two

serious national health problems -- the persistently high rate of low birthweight and

premature births, and the rising cost of health care.



Mr. Chairman and members of the Subcommittee, thank you for

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not only benefit the St. George's University School of Medicine

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The St. George's University School of Medicine has a growing

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teaching hospitals that treat and care for great numbers of poor

and indigent patients, 80-90% of residency positions are filled

by graduates of international medical schools.

In the United

States there would be a significant problem caring for indigent

and poor patients if not

for residency slots being filled by

eager graduates from non-U.S. schools such as St. George's.


Journal of the American Medical Association



January 18, 1985 issue reported that the St. George's University

School of Medicine had the highest initial pass rate of all the

leading international medical schools in the world on the U.S.

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approximately one-third of that class qualifies and transfers to U.S. medical schools to complete their education.

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In 1986, Congress reaffirmed during the Higher Education Act

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domestic medical schools will take the same licensing exam,


as the United States Medical Licensing Examination,

thereby allowing their skills to be compared on an equitable

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state-to-state licensure by endorsement process by limiting

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Chairman, I bring these examples to your attention to

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discriminatory barriers have begun to come down. However, there is no mistaking that discrimination toward graduates of foreign

medical schools is common, particularly in the areas of residency position acceptances, as well as in the areas of licensure, jobs, hospital promotions, privileges and peer reviews.

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FY'91 proposes a large cut in Health Education Assistance Loans

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